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Breast cancer

The document provides a comprehensive overview of breast cancer, detailing its introduction, types, risk factors, diagnosis, management, and prognosis. It emphasizes the prevalence of breast cancer among women, the importance of early detection through various diagnostic tools, and outlines treatment options ranging from surgical procedures to chemotherapy and hormonal therapy. Additionally, it covers nursing management strategies for patients undergoing treatment, addressing both physical and emotional needs.

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Breast Cancer PRESENTED BY:- KANIKA 3RD YEAR {Bsc. Nsg}
1) INTRODUCTION to BREAST CANCER 2) ANATOMY AND PHYSIOLOGY OF BREAST 3) TYPES OF BREAST CANCER 4) ETIOLOGY 5) RISK FACTORS and PROTECTIVE FACTORS 6) SIGNS and SYMPTOMS 7) DIAGNOSIS 8) MANAGEMENT 9) PROGNOSIS 10) PREVENTION TABLE OF CONTENTS
INTRODUCTION ● Breast cancer is the most common invasive cancer in women and the second leading cause of cancer death in women after lung cancer. ● According to the American Cancer Society, more than 193,000 cases of breast cancer are diagnosed each year, with an estimated 40,000 deaths. ● About 1% of these cancers occur in men.
ANATOMY and PHYSIOLOGY OF BREAST  Modified sweat gland.  Lies in superficial fascia of pectoral region.  Extended Vertically- from 2nd to 6th ribs.  Horizontally – lateral border of sternum to maxillary line  Lies on deep fascia (pectoral fascia) and separated from fascia by retro mammary space.
Breast has 3 components:- Nipple and areola Stroma Parenchyma
TYPES OF BREAST CANCER
BREAST CANCER BENIGN Fibrocystic Fibroadenomas Benign proliferative breast disease MALIGNANT Non invasive carcinoma Invasive carcinoma
BENIGN CONDITIONS
MANAGEMENT OF FIBROADENOMAS AGE<35 YEARS AGE>35 YEARS
MANAGEMENT OF FIBROCYSTS  For patients presenting with mastalgia, the first- line options are lifestyle changes as well as the avoidance of caffeine-containing food and beverages.  Use of a supportive bra, as well as altering the dose of hormone replacement therapy regimen. Analgesics such as aspirin and ibuprofen are options. If breast pain is severe for more than six months and disrupts daily activities, other therapies such as tamoxifen, bromocriptine, or danazol can be options. Fluid from cysts aspirated for symptomatic relief does not require cytological assessment.
BENIGN PROLIFERATIVE BREAST DISEASE Benign proliferative breast disease is a group of noncancerous conditions that may increase the risk of developing breast cancer. ATYPICAL HYPERPLASIA • Atypical hyperplasia is an abnormal increase in the ductal or lobular cells in the breast LOBULAR CARCINOMA in situ • (LCIS) is usually an incidental finding in breast tissue because it • cannot be seen on mammography and does not form a palpable • lump.
MANAGEMENT OF BENIGN PROLIFERATIVE BREAST DISEASE • To modify certain risk factors, such as diet, exercise, andalcohol consumption. LONG TERM SURVELLIANCE • It is a surgery to remove one or both breasts to reduce the risk of developing breast cancer PROPHYLACTIC MASTECTOMY • Tamoxifen has recently been shown to decrease the incidence of invasive breast cancer for high-risk women by 49% CHEMOPREVENTION
Non invasive carcinoma • Ductal • Lobular Invasive carcinoma • Infiltrating Ductal • Infiltrating Lobular • Mucinous carcinoma • Medullary Carcinoma • Tubular ductal carcinoma • Inflammatory carcinoma MALIGNANT CONDITIONS OF BREAST
NON INVASIVE CARCINOMA This disease is characterized by the proliferation of malignant cells within the ducts and lobules, without invasion into the surrounding tissue; therefore, it is a noninvasive form of cancer and is considered stage 0 breast cancer. DUCTAL CARCINOMA in situ{more common} LOBULAR CARCINOMA in situ
INVASIVE CARCINOMA Infiltrating Ductal Carcinoma •Infiltrating ductal carcinomas are the most common histologic type of breast cancer and account for 75% of all breast cancers. •These tumors are notable because of their hardness on palpation. • They usually metastasize to the axillary nodes. Infiltrating Lobular Carcinoma •Infiltrating lobular carcinoma accounts for 5% to 10% of breast cancers. • These tumors typically occur as an area of ill-defined thickening in the breast, as compared with the infiltrating ductal types. •They are most often multicentric •Lobular carcinomas may metastasize to meningeal surfaces or other unusual sites.
Medullary Carcinoma Medullary carcinoma constitutes about 6% of breast cancers and grows in a capsule inside a duct. This type of tumor can become large, but the prognosis is often favorable. Mucinous Cancer Mucinous cancer accounts for about 3% of breast cancers. A mucin producer, it is also slow-growing and thus has a more favorable prognosis than many other types. Tubular Ductal Cancer Tubular ductal cancer accounts for only 2% of cancers. Because axillary metastases are uncommon with this histology, prognosis is usually excellent.
ETIOLOGY • Research suggests that a relationship exists • between estrogen exposure and the development of breast cancer. HORMONES • Genetic alterations may be somatic (acquired) or germline (inherited) • A mutation in the BRCA-1 gene has been linked to the development of breast and ovarian cancer, • whereas a mutation in the BRCA-2 gene identifies risk for breast cancer GENETICS
RISK FACTORS and PROTECTIVE FACTORS BRCA-1 or BRCA-2 genetic mutation. Increasing age[ more than 50 years] Personal or family history of breast cancer Early menarche[ before 12 years of age] Nulliparity and late maternal age at first birth. Late menopause. History of benign proliferative breast disease. Obesity,hormonal replacement therapy,alcohol intake Regular exercise Breastfeeding Pregnancy before 30 RISK FACTORS PROTECTIVE FACTORS
ASESSMENT and DIAGNOSIS ASESSMENT DIAGNOSTIC PROCEDURES Breast examination can be done:- •Self breast examination •Clinical breast examination •Mammography •Galactography •USG For tissue analysis:- •Steretactic biopsy •Fine needle aspiration. •Excisional biopsy. •Incisional biopsy. •Needle localization.
 A clinical breast examination is recommended at least every 3 years for women ages 20 to 40 years.  It includes inspection and palpation of the breast. CLINICAL BREAST EXAMINATION
INSPECTION The breasts are inspected for size and symmetry. The skin is inspected for color, venous pattern, and thickening or edema. Erythema (redness) may indicate benign local inflammation or superficial lymphatic invasion by a neoplasm. Edema and pitting of the skin may result from a neoplasm blocking lymphatic drainage and giving the skin an orangepeel appearance (peau d’orange), a classic sign of advanced breast cancer.
PALPATION Palpation of the axillary and clavicular areas is easily performed with the patient seated.  To examine the axillary lymph nodes, the examiner gently abducts the patient’s arm from the thorax. The patient’s left forearm is grasped gently and supported with the examiner’s left hand. The right hand is then free to palpate the axillae and note any lymph nodes that may be lying against the thoracic wall. The flat parts of the fingertips are used to gently palpate the areas of the central, lateral, subscapular, and pectoral nodes
SELF BREAST EXAMINATION
DIAGNOSTIC EVALUATION •Mammography •Galactography •USG For tissue analysis:- •Stereotactic biopsy •Fine needle aspiration. •Excisional biopsy. •Incisional biopsy. •Needle localization.
MAMMOGRAPHY Mammography is a breast-imaging technique that can detect nonpalpable lesions and assist in diagnosing palpable masses. The procedure takes about 20 minutes and can be performed in an xray department or independent imaging center. Two views are taken of each breast: • craniocaudal view • mediolateral oblique view.
GALACTOGRAPHY Galactography is a mammographic diagnostic procedure that involves injection of less than 1 mL of radiopaque material through a cannula inserted into a ductal opening on the areola, followed by a mammogram.  It is performed when the patient has a bloody nipple discharge on expression, spontaneous nipple discharge, or a solitary dilated duct noted on mammography.
ULTRASONOGRAPHY  A transducer is used to transmit high- frequency sound waves through the skin and into the breast, and an echo signal is measured.  The echo waves are interpreted electronically and then displayed on a screen.
MRI A coil is placed around the breast, and the patient is placed inside the MRI machine for about 2 minutes.  An injection of gadolinium, a contrast dye, is given intravenously. MRI of the breast can be helpful in determining the exact size of a lesion or the presence of multiple foci more precisely than mammography.
TISSUE ANALYSIS PROCEDURES Fine-needle aspiration (FNA) is an outpatient procedure usually initiated when mammography, ultrasonography, or palpation detects a lesion.  Injection of a local anesthetic may or may not be used, but most times the surgeon or radiologist inserts a 21- or 22-gauge needle attached to a syringe into the site to be sampled. The syringe is then used to withdraw tissue or fluid into the needle. This cytologic material is spread on a slide and sent to the laboratory for analysis.
SURGICAL BIOPSY The procedure is usually done using local anesthesia, moderate sedation, or both. The biopsy involves excising the lesion and sending it to the laboratory for pathologic examination. EXCISIONAL BIOPSY Excisional biopsy is the usual procedure for any palpable breast mass.  The entire lesion, plus a margin of surrounding tissue, is removed. This type of biopsy may also be referred to as a lumpectomy
INCISIONAL BIOPSY Incisional biopsy is performed when tissue sampling alone is required; this is done both to confirm a diagnosis and to determine the hormonal receptor status. WIRE NEEDLE LOCALIZATION A long, thin wire is inserted, usually painlessly, through a needle before the excisional biopsy under mammographic guidance to ensure that the wire tip designates the area to undergo biopsy. The wire remains in place after the needle is withdrawn to ensure a precise biopsy.  The patient is then taken to the operating room, where the surgeon follows the wire down and excises the area around the wire tip.
EXAMINATION OF BREAST TISSUE Tissues obtained during biopsy are examined to determine: Malignant or Benign Type Invasive or Non - invasive Size Has it metastasized Is the lymph nodes affected Treatment
1. • SURGICAL MANAGEMENT 2. • RADIATION THERAPY 3. • CHEMOTHERAPY 4. • HORMONAL THERAPY
SURGICAL MANAGEMENT Surgery for breast cancer: Lumpectomy Mastectomy Lymph node surgery: Sentinel node biopsy Axillary lymph node dissection Breast reconstruction surgery
LUMPECTOMY Breast-conserving surgery (BCS) or partial/segmented mastectomy. Surgically removing the tumor and a small margin of healthy tissue around it Followed by radiation therapy
MASTECTOMY Surgically removing breast and other infected organs. MASTECTOMY Simple mastectomy Radical mastectomy Modified radical mastectomy
MASTECTOMY Simple mastectomy : Removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. Modified radical mastectomy: Simple mastectomy combined with the removal of the axillary lymph nodes. Radical mastectomy: A simple mastectomy combined with removing the lymph nodes and muscles of the chest wall.
LYMPH NODE SURGERY Axillary lymph node dissection: •About 10 to 40 lymph nodes are removed. •Usually done at the same time as the mastectomy or breast-conserving surgery. Sentinel lymph node biopsy: •It is used to determine if cancer has spread to the lymph nodes under the arm without removing many of them. • A blue dye/radioactive substance is injected in order to identify the sentinel lymph nodes which drains lymph from the tumor. •They are then removed.
BREAST CONSERVATION SURGERY •Surgical procedures aimed at recreating a breast so that it looks as much as possible like the other breast. • The surgeon may use a breast implant, or tissue from another part of the patient's body.
Breast-conserving surgery consists of :- •Lumpectomy •wide excision •partial or segmental mastectomy •quadrantectomy (resection of the involved breast quadrant) •removal of the axillary nodes (axillary lymph node dissection) for tumors with an invasive component, followed by a course of radiation therapy to treat residual, microscopic disease. The goal of breast conservation is to remove the tumor completely with clear margins while achieving an acceptable cosmetic result.
COMPLICATIONS Possible complications include:- •Accumulation of blood (hematoma) at the incision site •Infection •Late accumulation of serosanguineous fluid (seroma) after drain removal. •Nerve trauma with resultant phantom breast sensations • Numbness, •Tingling, or burning sensations may also occur •Impaired arm and shoulder mobility can result from the axillary dissection. •Lymphedema (chronic swelling of the affected extremity) •at any point after surgery
RADIATION THERAPY With breast-conserving surgery, a course of external beam radiation therapy usually follows excision of the tumor mass to decrease the chance of local recurrence and to eradicate any residual microscopic cancer cells. Radiation treatment is necessary to obtain results equal to those of removal of the breast Radiation treatment typically begins about 6 weeks after the surgery to allow the incision to heal.  If systemic chemotherapy is indicated, radiation therapy usually begins after completion of the chemotherapy.
Another approach to radiation therapy is the use of intraoperative radiation therapy (IORT), in which a single dose of radiation is delivered to the lumpectomy site immediately after the surgeon has performed the lumpectomy.
NURSING MANAGEMENT Self-care instructions for patients receiving radiation are based on maintaining skin integrity during and after radiation therapy: • Use mild soap with minimal rubbing. • Avoid perfumed soaps or deodorants. • Use hydrophilic lotions (Lubriderm, Eucerin, Aquaphor) for dryness. • Use a nondrying, antipruritic soap (Aveeno) if itching occurs. • Avoid tight clothes, underwire bras, excessive temperatures, and ultraviolet light. Patients may note increased redness and, rarely, skin breakdown at the booster site (tissue site that received concentrated radiation). Important aspects of follow-up care include teaching patients to minimize exposure of the treated area to the sun for 1 year and reassurance that minor twinges and shooting pain in the breast are normal reactions after radiation treatment.
CHEMOTHERAPY •Chemotherapy is administered to eradicate the micrometastatic spread of the disease. •Chemotherapy regimens for breast cancer combine several agents to increase tumor cell destruction and to minimize medication resistance •. The chemotherapeutic agents most often used in combination are  Cyclophosphamide (Cytoxan) (C)  Methotrexate(M),  Fluorouracil (F)  Doxorubicin (Adriamycin) (A).  Paclitaxel (Taxol) (T)
HORMONAL THERAPY  Normal breast tissue contains receptor sites for estrogen.  An ER+ assay indicates that tumor growth depends on estrogen supply; therefore, measures that reduce hormone production may limit the progression of the disease, and these receptors can be considered prognostic indicators  ER+ tumors may grow more slowly in general than those that do not depend on estrogen (ER−); thus, having an ER+ tumor indicates better prognosis.
Hormonal therapy may include surgery to remove endocrine glands (eg, the ovaries, pituitary, or adrenal glands) with the goal of suppressing hormone secretion. Oophorectomy (removal of the ovaries) is one treatment option for premenopausal women with estrogen-dependent tumors. Tamoxifen is the primary hormonal agent used in breast cancer treatment today. Anastrazole (Arimidex), letrozole (Femara), leuprolide (Lupron), megestrol (Megace), diethylstilbestrol (DES), fluoxymesterone (Halotestin), and aminoglutethimide (Cytadren) are other hormonal agents used to suppress hormone- dependent tumors
PROGNOSIS The prognosis also depends on whether the cancer has spread. For example, the overall 5-year survival rate is greater than 98% when the tumor is confined to the breast (ACS, 2002). When the cancer cells have spread to the regional lymph nodes, however, the overall 5-year survival rate falls to 76%. The 5-year survival rate for women diagnosed with metastatic disease is 16% At diagnosis, about 37% of patients have evidence of regional or distant spread or metastasis
NURSING MANAGEMENT Assessment  The health history includes an assessment of the patient’s reaction to the diagnosis and her ability to cope with it. Pertinent question include the following:  How is the patient responding to the diagnosis?  What coping mechanisms does she find most helpful?  What psychological or emotional supports does she have and use?  Is there a partner, family member, or friend available to assist her in making treatment choices?  What are the most important areas of information she needs?  Is the patient experiencing any discomfort?
NURSING DAIGNOSIS PREOPERATIVE NURSING DIAGNOSES • Deficient knowledge about breast cancer and treatment options • Anxiety related to cancer diagnosis • Fear related to specific treatments, body image changes, or possible death • Risk for ineffective coping (individual or family) related to the diagnosis of breast cancer and related treatment options • Decisional conflict related to treatment options
NURSING DAIGNOSIS POSTOPERATIVE NURSING DIAGNOSES • Acute pain related to surgical procedure • Impaired skin integrity due to surgical incision • Risk for infection related to surgical incision and presence of surgical drain. • Disturbed body image related to loss or alteration of the breast related to the surgical procedure • Risk for impaired adjustment related to the diagnosis of cancer, surgical treatment, and fear of death • Self-care deficit related to partial immobility of upper extremity on operative side • Disturbed sensory perception (kinesthesia) related to sensations in affected arm, breast, or chest wall
NURSING MANAGEMENT Fear and ineffective coping related to the diagnosis of breast cancer, its treatment, and prognosis. GOAL:- Reduction of emotional stress, fear, and anxiety INTERVENTIONS:- Begin emotional preparation of the patient (and partner) as soon as she is informed of tentative diagnosis.  Assess: a. Personal experience with and knowledge about breast cancer b. Coping mechanisms in crisis c. Support systems d. Emotional reaction to diagnosis Inform the patient of recent research and new treatment modalities for breast cancer. Describe the experiences the patient will face and encourage her questions. Acquaint her with available resources to facilitate her recovery.
NURSING MANAGEMENT Disturbed body image related to nature of surgery and side effects of radiation and/or chemotherapy Goal: Realistic adaptation to changes that will occur relative to treatment modalities INTERVENTIONS:- Confirm with the physician the nature of the treatment anticipated.  Explain that it is normal to experience grief at the loss of a body part.  Encourage visits by loved ones and understanding friends.  Explain that it is normal not to want herself or partner to view the incision do not refer to this as a “scar”); further reinforce the fact that each day the site will look better.  Discuss the use of prosthesis, reconstruction possibilities, and clothing adjustment as realistic and attainable expectations.
NURSING MANAGEMENT Acute pain related to tissue trauma from incision(s) Goal: Absence of pain and discomfort Assess intensity, nature, and location of pain. Administer analgesia by IM, oral, or IV route as prescribed. Collaborate with physician about use of patient-controlled analgesia (PCA). Explain that analgesics are available for pain relief. Proper body positioning will promote comfort, such as semi-Fowler’s position and elevation of the arm of the affected side. Promote passive and then active exercises of the hand, arm, and shoulder of the affected side. Encourage protection and the avoidance of anything that can break through the skin barrier to impose stress on the arm and shoulder (cuts, burns, strong detergents, infections, carrying a heavy bag or purse). Suggest application of an effective cream several times a day. Instruct patient to contact the physician if the arm or incision site becomes painful, swollen, or red. Suggest wearing a medical identification tag if there is a potential for injury or edema.
NURSING MANAGEMENT Dressing/grooming, bathing/hygiene self-care deficit related to partial immobility of upper extremity on side of breast surgery Goal: Avoidance of impaired mobility and achievement of self-care to the fullest possible level Encourage patient’s active participation in postoperative care. Encourage patient’s socialization, particularly with others who have successfully recovered in similar circumstances. Make progressive modifications in the patient’s exercise program as dictated by comfort and tolerance levels. Provide positive reinforcement when ingenuity and creativity are in evidence, such as an attractive hairstyle or make-up application.
NURSING MANAGEMENT Possible sexual dysfunction related to loss of body part and fear of partner’s reaction to this loss Goal: Identification of alternative satisfying/acceptable sexual experiences 1. Become comfortable in discussing sexuality; display a caring, nonjudgmental, supportive attitude.
RECONSTRUCTIVE SURGERY Reconstruction is a three-stage process that occurs over a period of months: 1. the first is creation of the breast mound, 2. the second is achieving symmetry with the contralateral Breast 3. the third is creation of the nipple–areola complex There are following reconstruction measures:- Breast Reconstruction Using Implants Breast Reconstruction Using Your Own Body Tissues (Flap Procedures) Reconstructing the Nipple and Areola After Breast Surgery
Breast Reconstruction Using Implants Several different types of breast implants can be used to rebuild the breast. Implants are made of a flexible silicone outer shell, and can contain: Saline: These implants are filled with sterile (germ- free) salt water. These types of implants have been used the longest. Silicone gel: Gel implants tend to feel a bit more like natural breast tissue.  Cohesive gel implants are a newer, thicker type of silicone implant.
Breast Reconstruction Using Your Own Body Tissues (Flap Procedures) A tissue flap procedure (also known as autologous tissue reconstruction) is one way to rebuild the shape of your breast after surgery to remove the cancer. The most common types of tissue flap procedures are: TRAM (transverse rectus abdominis muscle) flap, which uses tissue from the abdomen (tummy) Latissimus dorsi flap, which uses tissue from the upper back GAP (gluteal artery perforator) flaps (also known as a gluteal free flaps), which uses tissue from the buttocks TUG (transverse upper gracilis) flaps, which - uses tissue from the inner thigh
TRAM (transverse rectus abdominis muscle) flap
DIEP (deep inferior epigastric perforator) flap.
LAT(latissimus dorsal muscle)
GAP (gluteal artery perforator) flaps
TUG flap(transverse upper gracilis)
Reconstructing the Nipple and Areola After Breast Surgery A nipple is created using a skin graft from the inner thigh or labia because this skin has darker pigmentation than the skin on the reconstructed breast. After the nipple graft has healed, the areolar complex is usually completed with micropigmentation (tattooing).
PREVENTION OF BREAST CANCER
PHYSICAL EXERCISES DO NOT SMOKE REDUCE ALCOHOL CONSUMPTION BREAST FEED CONTROL OF WEIGHT LIMIT DOSE AND DURATION OF HRT
RESEARCH EVIDENCES The evolving meaning of cancer for long-term survivors of breast cancer Abstract Purpose/objectives: To discover the different meanings of cancer for older women who are long-term survivors of breast cancer. Design: Qualitative study using a heuristic approach. Setting: Large metropolitan area in the Midwestern United States. Sample: A sample of eight women was obtained using network sampling. The women ranged in age from 65-77 years. Length of survival ranged from 5.5-29 years. Five of the women had been treated with a lumpectomy (four with radiation and chemotherapy and one with radiation only). The three other women had been treated with a simple mastectomy, one of whom also was treated with chemotherapy. Methods: Interviews were conducted in the women's homes. Audiotaped interviews were transcribed and manually coded for patterns and themes. Main researchvariables: Meaning of cancer.
Findings: Three meanings of cancer emerged from the data (a) cancer as sickness and death (b) cancer as an obstacle, (c) cancer as transforming. Conclusions: As the women worked through their cancer experience, their perspectives changed. The meaning of cancer after surviving the disease and its treatment centered around positive, insightful experiences and expansive, renewing interactions with their environment. Further research examining the meaning of cancer is needed to broaden the transferability of the findings to other groups. Implications for nursing practice: Understanding the meaning of cancer for older women who are long-term breast cancer survivors may enhance nurses' sensitivity to survivors' perspectives. Knowledge of survivors' different meanings of cancer may help to paint a new vision of cancer survivorship comprised of potentially positive, transforming experiences.
Breast cancer can occur in women and rarely in men. Symptoms of breast cancer include a lump in the breast, bloody discharge from the nipple and changes in the shape or texture of the nipple or breast. Its treatment depends on the stage of cancer. It may consist of chemotherapy, radiation, hormone therapy and surgery. SUMMARY
I conclude my topic by saying that there could be a life after breast cancer and it can be treated and cured. I would like to thank sonia mam for giving me this opportunity to study on this topic. CONCLUSION
BIBLIOGRAPHY ●https://www.cancer.gov/about- cancer/understanding/what-is-cancer ●https://www.cdc.gov/cancer/breast/ basic_info/what-is-breast-cancer.htm ●https://www.cancer.org/cancer/brea st-cancer.html ●MSN by Brunners suddarth 10th edition